Abstract. Osteosarcoma is the most common malignant bone tumor that affects hundreds of children and young adults every year. The major prognostic factor in patients with localized osteosarcoma is the development of resistance towards preoperative chemotherapy. However, modifications of postoperative chemotherapy based on the histological response have not significantly improved the outcome of patients. Thus, it would be of tremendous clinical value if the poor responders could be identified at the time of diagnosis, so that ineffective therapy can be prevented and intensified or alternative therapy could be provided to improve their outcome. We hypothesized that plasma proteomic profiles could be used to distinguish good from poor responders prior to the start of treatment. In order to test this hypothesis, we analyzed the proteomic profiles in two sets of plasma samples (n=54) from osteosarcoma patients collected before (n=27) and after (n=27) pre-operative chemotherapy. Using a linear support vector machine algorithm and external leave-one-out cross validation, we developed two classifiers that classified good and poor responders with an equal accuracy of 85% (p<0.01 after 5000 permutations) in both sets of plasma samples. In order to understand the biological basis of the classifiers, we further identified and validated two plasma proteins, serum amyloid protein A and transthyretin, in the classifiers. Our results suggest that plasma proteomic profiles can predict chemotherapy response before treatment as accurately as after treatment. Our study could lead to the development of a simple blood test that can predict chemotherapy response in osteosarcoma patients. Since the two identified proteins are involved in innate immunity, our findings are corroborated by the notion that boosting the innate immunity in conjunction with chemotherapy, achieves a better anti-tumor activity, thus improving the overall survival of osteosarcoma patients.
IntroductionOsteosarcoma is a primary malignant bone tumor bone arising from primitive bone-forming mesenchymal cells and is characterized by the production of osteoid material (1). It is a common malignant bone tumor occuring in children and accounts for ~60% of malignant bone tumors which occur during the first two decades of life (2). Since the 1970s, the accepted standard of care for osteosarcoma involves four steps: Diagnosis by an initial biopsy, pre-operative chemotherapy, definitive surgery to resect the tumor, and postoperative chemotherapy (Fig. 1). Besides facilitating limbsparing procedures by shrinking the tumor, pre-operative chemotherapy can theoretically be used as an in vivo indicator of the chemosensitivity of an individual tumor, thus providing a guide for the customization of post-operative chemotherapy. However, the strategy of pre-operative chemotherapy has not improved disease-free survival for patients with osteosarcoma. Despite a number of multi-institutional clinical trials of pre-operative chemotherapy in both Europe and North America, the overall su...